Abstract
BACKGROUND: According to published data, the pathogenetic link between chronic periodontitis and morbid obesity (body mass index 40 kg/m²) is mediated by gastrointestinal dysbiosis, systemic inflammation, oxidative stress, and endotoxemia. Bacterial toxins and inflammatory mediators circulating in the bloodstream of obese patients contribute to progressive destruction of periodontal tissues and reduce the effectiveness of regenerative processes during periodontitis treatment. Therapy for such patients should include measures to normalize the intestinal microbiota composition. AIM: To evaluate the effect of conservative treatment with probiotics on periodontal tissue status and molecular biomarkers in patients with periodontitis concurrent with obesity and dysbiosis. METHODS: The study included 70 individuals (aged 45–59 years) with chronic periodontitis, morbid obesity, and intestinal dysbiosis, divided into two equal groups. Patients in group 1 (n = 35) received, in addition to standard therapy, a complex of live Lactobacillus and/or Bifidobacterium strains (Bifilyuks, Russia) combined with a prebiotic (lactitol) and metabiotics. Patients in group 2 (n = 35) received standard periodontitis therapy consisting of ultrasonic removal of dental deposits, surface polishing, and antiseptic treatment. Treatment efficacy was assessed at 3, 6, 9, and 12 months using the Russell Periodontal Index and probing pocket depth. Additionally, cytokine and osteomarker concentrations in periodontal exudate were monitored at 3 and 6 months. RESULTS: After treatment, both groups showed significant reductions in periodontal index scores and probing pocket depth, indicating resolution of periodontal inflammation. However, the additional use of probiotics in group 1 resulted in a more pronounced reduction in the Russell Periodontal Index compared to group 2, particularly during the first 3–9 months. Concentrations of interleukin-8, tumor necrosis factor-alpha, and cathepsin K were also significantly lower after treatment in group 1. CONCLUSION: The use of synbiotics as part of comprehensive conservative treatment in patients with periodontitis, obesity, and dysbiosis demonstrated high anti-inflammatory efficacy, as evidenced by clinical parameters and molecular markers of inflammation and bone resorption.